Endotracheal tube with valved balloon having removable inflation means and balloon rupturing means associated therewith



Sept. 24, 1968 G. o. DOHERTY 3,402,718

ENDOTRACHEAL TUBE WITH VALVED BALLOON HAVING REMOVABLE INFLATION MEANSAND BALLOON RUPTURING MEANS ASSOCIATED THEREWITH Filed Aug. 12, 1965 2Sheets-Sheet 1 x r I I 2 o u. i

INVENTOR es RGE o OHERTY ATTORNEY Sept. 24, 19 e. o. DOHERTYENDOTRACHEAL TUBE WITH VALVEI) BALLOON HAVING REMOVABLE INFLATION MEANSAND BALLOON RUPTURING MEANS 2 t e e h a s t e e h s 2 H T I w E R E H TD E T A I C O S S A :U 6 9 l 2 l g u A d e l 1 F INVE N TOR OHERTYATTORNEY 0&0

United States Patent 3,402,718 ENDOTRACHEAL TUBE WITH VALVED BALLOONHAVING REMOVABLE INFLATION MEANS AND BALLOON RUPTURING MEANS ASSOCIATEDTHEREWITH George 0. Doherty, 2301 River Road, Missoula, Mont. 59801Filed Aug. 12, 1965, Ser. No. 479,228 14 Claims. (Cl. 128-351) ABSTRACTOF THE DISCLOSURE An endotracheal tube including an open-ended tubehaving an aperture opening into an inflatable cuff at one end of thetube. A check valve covers the aperture, and a smaller diameter tubularinflation conduit extends from the aperture, into which its inner end isremovably fitted, through the tube for connection to an external sourceof pressurized gas. A string extends along the external surface of thetube to the cuff, to which it is attached, for rupturing and therebydeflating the cuff.

This invention relates in general to endotracheal tubes and, moreparticularly, to endotracheal tubes which can be readily installed andeasily removed.

In many types of surgical procedures it is the practice to install anendotracheal tube through the patients mouth and into the trachea inorder to administer anesthetics or oxygen and to control the patientsrespiration. The rear or proximal end of the tube which projectsexternally from the patients mouth is suitably attached to an anesthesiamachine which provides a flow of desired gases.

One type of endotracheal tube which has been in use for many yearscomprises a soft, flexible, relatively largediameter piece of tubingwhich is of such size as to pass through the larynx and into thevestibular portion of the trachea. At its inserted end, the tubing isprovided with a slidably adjustable sleeve-like inflatable rubber cuffand some kind of a secondary tube by which the cuff can be inflatedthereon. The opposite end of the secondary tube is usually provided witha syringe bulb for inflating the cuff. Generally, the cuff is positionedon the tubing so that when the latter is fully inserted, the cuff willlie in the trachea beyond the sphincter muscles of the larynx. Suchcuffs, however, have proved rather unsatisfactory because thesleeve-like element which forms the cuff frequently slides upwardly overthe tube upon encountering a restricted organ such as the sphinctermuscles of the larynx, and the small secondary tube leading from thecuff often becomes twisted and tangled. These difficulties led to thedevelopment of the so-called Riisch tube which employs an inflatablecuff that is built integrally into, and forms a part of the tube. Thesmall secondary tube used to inflate the cuff passes internally throughthe Riisch tube to the portion surrounded by the cuff where it isconnected through the wall of the tube to the internal chamber of thecuff. However, the Riisch type endotracheal tube is comparativelyexpensive, and the internally disposed inflation tube can interfere withthe insertion of surgical instruments through the tube. This makes itdifficult to use in many instances.

It is, therefore, the primary object of the present invention to providean endotracheal tube which is combined with a removable inflation tube.

It is another object of the present invention to provide an endotrachealtube having a securely attached cuff which can be inserted within thetrachea to form a tight seal and can be easily deflated to permit quickand simple removal of the endotracheal tube at the end of the operationor in case of some emergency.

3,402,718 Patented Sept. 24, 1968 It is an additional object of thepresent invention to provide an endotracheal tube which is relativelysimple in construction and economical to manufacture.

It is further an object of the present invention to provide anendotracheal tube which is completely disposable.

It is still a further object of the present invention to provide anendotracheal tube which can easily be sterilepacked for simplicity inshipping, storage, and ultimate use.

With the above objects in view, my invention resides in the novelfeatures of form, construction, arrangement, and combination of partspresently described and pointed out in the claims.

In the accompanying drawings (2 sheets):

FIG. 1 is a top plan view of an endotracheal tube constructed inaccordance with and embodying the present invention;

FIG. 2 is a sectional view taken along line 2-2 of FIG. 1,

FIGS. 3 and 4 are transverse sectional views taken along lines 3-3 and44 of FIG. 2;

FIG. 5 is an enlarged fragmentary sectional view of the endotrachealtube showing the cuff inflated and the valve flap closed;

FIG. 6 is a top plan view of a modified form of the present invention,

FIG. 7 is a longitudinal sectional view taken along line 7-7 of FIG. 6,and

FIG. 8 is a longitudinal sectional view of a further modified form ofendotracheal tube constructed in accordance with and embodying thepresent invention.

Referring now in more detail and by reference characters to the drawingswhich represent practical embodiments of the present invention, Adesignates an endotracheal tube including a flexible, relatively softtube 1 made of polyethylene, polypropylene or similar flexible material.Tube 1 is of sufficient length to extend from the vestibular portion ofa patients trachea immediately caudad to the larynx and through thepatients mouth, projecting outwardly therefrom. Attached externally toand disposed encirclingly around the distal or forward end of tube 1(reference being made to the right end as shown in FIG. 1) is aninflatable cuff 2 which is preferably constructed from some suitableflexible material which will balloon out under air or gas pressure. Theannular margins of cuff 2 are adhesively or otherwise suitably sealed tothe wall of the tube 1, thereby creating an annular chamber 3 betweenthe outer surface of tube 1 and the inner surface of cuff 2. Tube 1 isprovided with an opening or aperture 4 which provides communicationbetween the internal bore of tube 1 and the air chamber 3. Secured alongone margin to tube 1 and completely covering aperture 4 is valve flap 5which is preferably made of rubber and will normally lie in closureforming position over the aperture 4 but can swing outwardly into openposition to admit air or gas into the chamber 3. Thus, valve flap 5creates a unidirectional air valve over aperture 4, all as best seen inFIG. 2 and for purposes presently more fully appearing.

Extending axially through the tube 1 is a flexible small bore inflationtube or conduit 6 made of a relatively flexible material and being bentover at its inner end in the provision of a small tip 7 which is snuglypress-fitted into the aperture 4 and preferably terminates flus'h withthe outer surface of the tube 1. At its proximal or rear end, theinflation tube 6 projects outwardly from the tube 1 to provide asufficiently long external portion for convenient manipulation. Thuswhen air or gas is injected, by syringe or any other means, through theinflation tube 6, this air or gas will flow through the aperture 4flexing the valve flap 5 away from closure-forming position andinflating the cuff 2. However, when the cuff 2 is inflated the pressurein the chamber 3 will force the valve flap 5 into-sealing engagementwith the outwardly presented margins of aperture 4, thereby preventingthe escape of air or loss of pressure within the air chamber 3. In thisregard, it should be noted that valve flap 5 should be constructedsothat only a moderate increase in pressure within the tube 1 will liftit away from aperture 4.

When the cuff 2 has been suitably inflated, the external end of theinflation tube 6 can be sharply pulled to the rear and the tip 7 willbecome disengaged with the aperture 4. The inflation tube 6 can then beremoved and discarded. Subsequently, when the surgical or otherprocedure requiring the endotracheal tube A is concluded, theendotracheal tube A can be removed by simply inserting a wire or metalrod (not shown) axially through the tube 1 and gently feeling for theaperture 4. When the aperture 4 is located, the wire or rod can bepushed through the aperture 4 far enough to flex the valve flap awayfrom closure-forming position and allow the air or gas which is trappedin the chamber 3 to escape. Thereupon the endotracheal tube A can beeasily pulled out of the patients throat. To facilitate location of theaperture 4, a suitable indicia-mark m may be imprinted or otherwiseapplied to the external face of the proximal end of tube 1 at a pointaxially outwardly from, and diametrally opposite the aperture 4.

After manufacture and assembly, the endotracheal tube A should besuitably sterilized and cuff 2 should be deflated so that it clingssnugly to the wall of tube 1. The endotracheal tube A is then sealed ina sterilized package so that it may be used immediately by a hospitalupon removal from the package.

Immediately before the operation, the endotracheal tube A is removedfrom the package, and smeared with a lubricant such as Xylocaine jellywhich has anesthetic properties to lessen irritation upon placement. Theanesthesiologist then inserts the forward end of tube 1 into thepatients mouth and through the larynx. When the cuff 2 has passed thesphincter muscle of the larynx and entered the vestibular portion of thetrachea, the cuff is inflated as above described.

It is possible to provide a modified endotracheal tube B substantiallyas shown in FIG. 6, which is very similar to endotracheal tube A andincludes a soft flexible tube 11, a cuff 12, forming an annular chamber13. The tube 11 has an aperture 14 opening into the chamber 13.Operatively disposed over aperture 14 and having one lateral marginadhesively or otherwise suitably sealed to tube 11 is a valve flap 15preferably made from a thin very flexible sheet of soft rubber. Thevalve flap 15 serves the same function as the valve flap 5 that is tosay, it acts as a unidirectional air valve over aperture 14 permittinginflation of cuff 12 through an inflation tube 16 when air or gaspressure is applied in the same manner as previously described.

Extending loosely and axially along the side of the tube 1 11 is aribbon-like strip 17 made of tough flexible material.

At its rear end the strip 17 projects outwardly beyond the rear ordistal end of the tube ;11 to provide an external portion 18 which islong enough for convenient manipulation. The strip 17 is sealed into andextends through the rear annular joint between the tube 11 and the cuff12, and projects loosely into the chamber 13, being adihesively securedor otherwise firmly attached at its inner end 19 to the interior face ofthe cult 12.

The endotracheal tube B is inserted within the patients throat in thesame manner as the previously described endotracheal tube A andconventionally connected to an anesthesia machine. Its cuff 12 isinflated by directing a pressurized gas such as air through inflationtube 16 and that gas will open valve flap 15 and fill cufl 12. After thecuff 12 has been fully inflated it can be quickly and easily deflated bygrasping and pulling the external portion 18 of the strip 17. The forcethereby exerted on the strip 17 will rupture the annular marginal sealbetween the cuff 12 and the tube 11 whereby to deflate the 4 cuff 12 andpermit removal of the endotracheal tube B.

It is also possible to provide a further modified form of endotrachealtube C as shown in FIG. 8 which is similar to the endotracheal tube Aand includes a soft flexible tube 21 and a cuff 22 forming an annularchamber 23. The tube 21 has an aperture 24 opening into the dhamber 23.

Extending looselyand axially .throughthe tube 21 is a flexible smallbore inflation tube 25 made of relatively flexible material and beingbent over at its inner end in the provision of a small tip 26' which issnugly pressfitted into the aperture 24 and communicates with thechamber 23. Operatively sealed or otherwise secured across the inner endof the tip 26 is a valve flap 27 which functions as a unidirectionalcheck valve so that air or gas passing under pressure through the tip 26will flex the valve flap 27 into the open position and permit the air orgas to enter the chamber 23 so as to inflate the cup 22. As in the caseof the previously described embodiment, when the flow of air or gasthrough the inflation tube 25 is stopped, the pressure which is built upwithin the chamber 23 will cause the valve flap 27 to close and the cuff22 will remain inflated. In the endotracheal tube C, however, the valveflap 27 forms a part of and is carried by the tip 26 of the inflationtube 25. Moreover, the inflation tube 25 projects outwardly from theproximal or rear end of the tube 21 thereby providing a terminal portion28 which can be conveniently manipulated. When it becomes necessary toremove the endotracheal tube C, this terminal portion 28 can be graspedand sharply pulled outwardly disengaging the tip 26 from the aperture 24and pulling it and the valve flap 27 outwardly whereupon the aperture 24is opened and the cuff 22 will deflate immediately.

It is readily apparent that endotracheal tubes A, B, and C, beingrelatively simple in design are obviously economical to manufacture.Because of the low cost the hospital can discard the used tubes uponcompletion of the operation, and it need not worry over transferringinfections from one patient to another through reuse of the tubes. Thetubes, being simple in construction, have few parts which interfere withthe conduct of the operation, or obstruct the anesthesiologists view andinterfere with his movements. Moreover, the simple construction isadapted to reduce patient irritation to an absolute minimum. It shouldbe noted that endotracheal tubes and analogous tubes of similar designbut differing in size can 'be constructed for use with patients ofdifferent sizes as well as for insertion in other body canals such asthe ureter.

It should be understood that changes and modifications in the form,construction, arrangement, and combination of the several parts of theendotracheal tubes may be made and substituted for those herein shownand described without departing from the nature and principle of myinvention.

Having thus described my invention, what I claim and desire to secure byLetters Patent is:

1. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecrosssectional size and shape of the duct, a pressure-expensiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means Operatively associated with the opening forpermitting unidirectional flow of a fluid medium into the chamberwhere-by to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, and conduit means removably inserted within saidopening for causing a fluid medium under pressure to flow through theopening and distend the membrane.

2. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecrosssectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means operatively associated with the opening forpermitting unidirectional flow of a fluid medium into the chamberwhereby to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, and conduit means removably fitted within saidopening at one end and being adapted to be operatively connected to asource of pressurized fluid at its opposite end.

3. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecrosssectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means operatively associated with the opening forpermitting unidirectional flow of a fluid medium into the chamberwhereby to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, and an inflation tube removably inserted withinsaid open-ended tube for conveying said fluid medium to said chamber,said inflation tube having one end removably connected to said openingand its other end projecting beyond the proximal end of said tube foroperative connection to a source of pressurized fluid medium.

4. Means for establishing a passageway through a duct in the human bodyaccording to claim 3 in which said check valve means is a flap-likevalve element disposed within said chamber and adapted to cover saidopening.

5. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed annularly with respect thereto whereby to form an annularchamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means operatively associated with the opening forpermitting unidirectional flow of a fluid medium into the chamberwhereby to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, and an inflation tube removably inserted withinsaid open-ended tube for conveying said fluid medium to said chamber,said inflation tube being provided at one end with an elbow adapted forsnug-fitting engagement with said opening, the other end of saidinflation tube projecting beyond the proximal end of said open-endedtube for operative attachment to a source of pressurized fluid medium.

6. Means for establishing an artificial passageway through a duct in thehuman body such .as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, an inflation tube removably inserted within said open-endedtube for conveying said fluid medium to said chamber, said inflationtube being removably and snugly fitted within said opening, and aunidirectional air valve carried by said inflation tube for permitting afluid medium to enter said chamber but not escapte therefrom.

7. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal .and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, an inflation tube removably inserted within said open-endedtube for conveying said fluid medium to said chamber, said inflationtube being removably and snugly fitted within said opening, and aunidirectional air val e carried by the end of said inflation tubedisposed within said opening.

8. Means for establishing an artificial passageway through a duct in thehuman body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube provided with an opening establishing communicationbetween the interior of the tube and the interior of the chamber, checkvalve means operatively associated with the opening for permittingunidirectional flow of a fluid medium into the chamber whereby todistend the membrane and create a bulbous external enlargement on thetube for retentive engagement with the tissues along a portion of theduct, conduit means removably inserted in said opening and extendingthrough said tube for introducing a pressurized fluid medium into thechamber, and means attached to said membrane for rupturing said membranewhile the same is operatively disposed within the duct.

'9. Means for establishing an artificial passageway through a duct inthe human body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means operatively associated wi h the opening forpermitting unidirectional flow of a fluid medium into the chamberwhereby to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, conduit means removably inserted in said openingand extending through said tube for introducing a pressurized fluidmedium into the chamber, and means attached to said membrance forrupturing said membrane while the same is operatively disposed withinsaid duct, said last-named means being disposed externally of theopen-ended tube and being operable from the proximal end of said tube. vI

V10. v ,Means for establishing an artificial passageway through a ductin the human body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and .across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube adjacent its distal end andbeing disposed externally with respect thereto whereby to form achamber, said tube being provided with an opening establishingcommunication between the interior of the tube and the interior of thechamber, check valve means operatively associated with the opening forpermitting unidirectional flow of a fluid medium into the chamberwhereby to distend the membrane and create a bulbous externalenlargement on the tube for retentive engagement with the tissues alonga portion of the duct, conduit means removably inserted in said openingand extending through said tube for introducing a pressurized fluidmedium into the chamber, and a ribbon-like strip adapted to lay againstthe outside of said open-ended tube and extend beyond the proximal endthereof when said tube is operatively inserted within the duct, saidribbon-like strip being operatively secured to the wall of said membraneso as to rupture the same when said strip is pulled with respect to theopen-ended tube.

-11. Means for establishing an artificial passageway through aduct inthe human body such as the trachea, ureter, or the like; said meanscomprising an open-ended tube having proximal and distal ends and across-sectional size and shape substantially similar to thecross-sectional size and shape of the duct, a pressure-expansiblemembrane marginally secured to the tube and being disposed externallywith respect thereto whereby to form a chamber, said tube being providedwith an opening establishing com munication between the interior of thetube and the interior of the chamber, check valve means operativelyassociated with the opening for permitting unidirectional flow of afluid medium into the chamber whereby to distend the membrane and createa bulbous external enlargement on the tube for retentive engagement withthe tissues along a portion of the duct, conduit means removablyinserted in said opening and extending through said tube for introducinga presurized fluid medium into the chamber, and a ribbon-like stripadapted to lay against the outside of said open-ended tube and extendbeyond the proximal end thereof when said tube is operatively insertedwithin the duct, said ribbon-like strip extending through the junctureof said open-ended tube and said membrane and being secured to saidmembrane within said chamber whereby to rupture said membrane whenpulled with respect to said open-ended tube.

12. Means for establishing an artificial passageway through a duct inthe body; said means comprising an open-ended tube having proximal anddistal ends and being sized for at least partial insertion into theduct, a flexible cuff fitted around the tube adjacent its distal end forinsertion into the duct and being in sealingwise engagement with thetube at two spaced locations so as to form a fluid chamber intermediatethe walls of the tube and cuff, the tube having an aperture opening intothe chamber, a check valve at the aperture for permitting aunidirectional fiow of fluid into the chamber through the aperture, anda tubular conduit extending from the proximal end of the tube throughthe tubes interior and terminating within the tube at a tip sized forforcibleinsertion into the aperture, the tip being removable from theaperture so that the conduit can be withdrawn whereby an unobstructedpassageway exists through the open-ended tube while it is in the duct.

13. Means for establishing an artificial passageway according to claim12 wherein the conduit extends substantially axially through the tubeand the tip is presented substantially perpendicular to the axiallyextending portion pf the conduit.

14. Means for establishing an artificial passageway according to claim13 wherein the check valve is located over the opening on the outwardlypresented surface of the tube.

References Cited UNITED STATES PATENTS 281,043 7/1883 Finney 1282461,887,392 11/1932 Bacon 128-2 2,813,531 11/1957 Lee 12835O 2,876,7673/1959 Wasserman 128-151 DALTON L. TRULUCK, Primary Examiner.

